Therapeutic Use Exemptions
If an athlete is tested, any substances that an athlete may be taking must be declared in testing paperwork, in addition to any TUE that the athlete has.
Athletes may at times need to use a prohibited medication to treat a legitimate medical condition.
A Therapeutic Use Exemption (TUE) is an exemption that allows an athlete to use, for therapeutic purposes only, an otherwise prohibited substance or method (of administering a substance) which may be present during competition.
WADA's 2011 Prohibited List includes a change of status to the therapeutic use of inhated Beta-2 agonists, salbutemol (e.g. ventolin) and salmeterol (e.g. seretide and serevent):
- Therapeutic use of inhaled salbutamol (maximum 1600 micrograms per day) and salmeterol will be permitted in sports as of 1 January 2011. No Therapeutic Use Exemption (TUE) application is necessary. WADA have also removed the need for athletes to declare the use for these substances during a doping control (testing) session. Athletes are free to use salbutamol (maximum 1600 micrograms per day) and salmeterol in and out of competition in their chosen sport.
Salbutamol will still be prohibited in urinary concentrations above 1000 nanograms per millilitre. There will be a presumption that the substance was not taken by inhalation and the athlete will have to demonstrate through a controled pharmokinetic study that the level found in their urine was the result of therapeutic inhaled use. Athletes are advised not to overuse their salbutamol inhalers.
- Prohibited Beta-2 agonists including formoterol and terbutaline will still require an in-advance TUE and meet WADA's specific criteria of a positive bronchial provocation test or positive bronchodilator test as per the 'Suggested Medical File Requirements' [below].
- ALL athletes and athletes who are in an International Federation Registered Testing Pool (RTP), ASADA's RTP and athletes in ASADA's Domestic Testing Pool (DTP) must have an in-advance TUE to inhale prohibited Beta-2 agonists.
For an athlete with well documented asthma who undertakes one or more bronchial provocation tests which are negative, there is a possibility that a TUE may be approved if a comprehensive
medical file is submitted together with all details of the negative bronchial provocation test(s).
Suggested Medical File Requirements for Prohibited Beta-2 agonists TUE
- Athlete's age of onset
- Trigger factors, for example exercise or allergies
- Associated allergic or a topic conditions
- History of any hospitalisation, including accident and emergency presentations (if any)
- All current medication, and any previous asthma medications trialed
- Previous requirements for oral glucocorticosteroids
- Relevant family history
- Clinical examination with particular reference to respiratory system
Current evidence of asthma
- Relevant tests including skin prick, RAST etc.
- Any spirometry
- Any previous bronchial provocation tests, regardless of age
One positive result is required, but if a bronchial provocation test is negative, athletes can submit the application with the medical file and negative test for consideration.
The evidence must include either:
- Reversible airway obstruction:
- Evidence of airway obstruction with a 12% increase in FEV1 after the administration of an
inhaled Beta-2 agonist, or
- Bronchial provocation tests
- Mannitol - 15% fall in FEV1
- Hypertonic Saline - 15% fall in FEV1
- EVH - 10% fall in FEV1
- Exercise Challenge tests - 10% fall in FEV1
- Methacholine - 20% fall in FEV1
- Ensure the athlete ceases inhaled steroids and long acting Beta-2 agonists before the test (a minimum of 24 hours is suggested) and short acting Beta-2 agonists for at least 8 hours prior to the test. The longer an athlete is off the medication, the more likely that he/she will return a positive bronchodilator test or
bronchial provocation test.
- If an athlete is unsure whether they are in an RTP or DTP they should contact their national sporting organisation.
For more information on asthma visit the Asthma Foundation website.
Apply for a TUE through ASDMAC
TUE approval may protect athletes from receiving a sanction if a prohibited substance is found in their sample.
If an athlete’s doctor has a question regarding the status of a substance, they should check the substance on the ASADA website, or call 13 000 ASADA (13 000 27232), while the athlete is in their office.
An exemption is only granted provided that there is no unfair advantage given to the athlete by taking the substance or using the method.
Before applying for a TUE, athletes must check with their sporting organisation to see if TUEs are allowed under their sport’s anti-doping policy.
Under the World Anti-Doping Code's strict liability policy you, the athlete, are responsible for any substance found in your body regardless of how it got there. You must check the status of any substance and method before using it.
Remember to tell your doctor that you are an athlete who is subject to doping control.
Watch a video on Therapeutic Use Exemptions [streaming FLV - 15.09MB]